Surgical access sheath and methods of use

ABSTRACT

In a surgical method, an access sheath is provided by a tube of a braided material. A first end of the sheath may be folded. The first end, folded or unfolded, is grasped with a distal end of a tool, which is then inserted into the nose of a patient. Advancing the tool pulls the distal end of the sheath into the nose of the patient. The sheath is then released from the tool and the tool is withdrawn. A portion of the sheath may be optionally cut off to shorten the sheath to a desired length. Typically the sheath has a total length of 70 to 180 mm and an outside diameter of 12 to 50 mm. The sheath may have a constant outside diameter along its length. The sheath may comprise silicone on the braided material.

CROSS-REFERENCE TO RELATED APPLICATION(S)

This application claims priority to U.S. Provisional Application No. 62/776,111 filed Dec. 6, 2018 and incorporated herein by reference.

BACKGROUND

Endoscopic surgery within the head is a common procedure in neurological surgery and otolaryngology. It avoids large cranial incisions and can reduce the need for brain retraction and prolonged wound healing. Endoscopic surgery within the head also provides improved illumination and visualization of the target tissues because the camera of the endoscope is brought directly to the surgical site.

During this type of surgery, there may be local trauma to the tissues in the surgical pathway, resulting from pressure or abrasion caused by the surgical tools. Generally these tissues are the nasal mucosa, turbinates, nasal septum, and sphenoid/frontal/maxillary sinus. Surgical pathway trauma can add to the trauma of the procedure and prolong the patient's recovery time. Liquids in the surgical pathway, such as mucous, blood, and soiled irrigation fluid, tend to obscure the view of the endoscope. This leads to the constant need for irrigation and suction of the obstructing liquids. In some cases the endoscope may also have to be removed, cleaned and replaced multiple times during a single procedure. This disadvantage tends to increase the complexity and time requirements of the operation. In addition, with each movement of a surgical tool into or out of the surgical pathway, the surrounding tissues are put at risk of additional trauma. Improved devices and methods are therefore needed.

SUMMARY

An access sheath is provided to protect the nasal passageway during endoscopic trans nasal or intra ocular surgery. The access sheath protects the entrance of the nares and sinus from the placement and manipulation of surgical tools both during the initial placement and during manipulation and exchange of surgical tools. The access sheath may provide a guide port to help direct surgical tools into position.

In a surgical method, an access sheath is provided by a tube of a braided material. A first end of the sheath may be folded. The first end, folded or unfolded, is grasped with a distal end of a tool, which is then inserted into the nose of a patient. Advancing the tool pulls the distal end of the sheath into the nose of the patient. The sheath is then released from the tool and the tool is withdrawn. A portion of the sheath may optionally be cut off to shorten the sheath to a desired length. Typically the sheath has a total length of 60 to 180 mm and an outside diameter of 12 to 40 or 50 mm. The sheath may have a constant outside diameter along its length. The sheath may have a layer of silicone on the braided material.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a front perspective view of a tubular braided access sheath and a deployment tool alongside a human head model.

FIG. 2 is a perspective view of the sheath of FIG. 1 now folded to prepare it for deployment.

FIG. 3 is a perspective view of a deployment tool grasping the folded distal end of the sheath shown in FIG. 1 or 2 .

FIG. 4 is a perspective view showing the deployment tool grasping the distal end of the sheath of FIG. 1 or 2 and pulling it into the nasal cavity of the human head model.

FIG. 5 is a perspective view showing the sheath of FIG. 1 or 2 now deployed and expanded in place conforming to the nasal cavity and naris of the human head model, simulating use in a human patient.

FIG. 6 is a perspective view showing the proximal end of the sheath being trimmed to a desired length using a scissor.

FIG. 7 is a perspective view showing the final configuration of the sheath deployed in the human head model and trimmed to the desired length.

DETAILED DESCRIPTION

As shown in FIG. 1 , an access sheath 20 may be provided as a length of tubular braided material. Generally, the sheath is flexible and can conform to varying anatomies. The sheath 20, for example in the form of a braided tube, requires no special features or shaping. The distal end of the braided tube 20 may optionally be sealed, folded, bonded, etc., to prevent fraying. The braided tube may advantageously have a coating of a sealing material such as silicone, for example as described in U.S. Patent Application Publication No. 2019/0104929, incorporated herein by reference.

As shown in FIG. 2 , the tubular access sheath 20 may be folded to prepare it for deployment. In the example shown, the tubular shape of the sheath 20 allows any side of sheath to be folded to the opposite side. In this case the sheath 20 has no specific top/superior or bottom/inferior side. FIG. 3 shows a deployment tool 22 grasping the folded distal end of the access sheath 20. FIG. 4 shows the deployment tool 22 grasping the distal end of the access sheath 20 and pulling it into the nasal cavity. The sheath can be placed to user's preferred distal position as the length of the sheath is customizable by trimming the proximal end.

FIG. 5 shows the sheath 20 now deployed and expanded in place conforming to the nasal cavity and naris of the patient. The naris constricts the expanded sheath 20 to hold it in place and help to minimize migration in or out of the nasal cavity. The extra length of the second or proximal end of the sheath 20 is exposed, leaving 5 to 30 mm of a second end of the sheath projecting out of the nose and ready to be cut off. FIG. 6 shows the proximal end of the sheath 20 being trimmed to a preferred length, using a cutting tool, such as a scissors. FIG. 7 shows the final configuration of sheath 20 now trimmed to the desired length. The sheath 20 may be trimmed on the proximal exposed end so that any fraying of the braid would not touch the patient.

The sheath may be designed and manufactured and described in U.S. Patent Application Publication Nos. US2017/0347865 and 2019/0104929, incorporated herein by reference.

Thus, novel sheaths and methods have been shown and described. Various changes and substitutions may of course be made without departing from the spirit and scope of the invention. The invention, therefore, should not be limited, except to the following claims and their equivalents. 

The invention claimed is:
 1. A surgical method, comprising: providing a surgical sheath comprising a tube of braided material; grasping a first end of the sheath with a distal end of a tool; inserting the distal end of the tool into the nose of a patient; using the tool to pull the first end of the sheath into the nose of the patient; releasing the first end of the sheath; and cutting off a portion of a second end of the sheath.
 2. The method of claim 1 wherein 5 to 30 mm of the sheath projects out of the nose after the sheath is pulled into the nose.
 3. The method of claim 1 wherein the tube has a circular cross section that is uniform along the length of the tube.
 4. The method of claim 1 wherein the sheath has a constant outside diameter along its length.
 5. The method of claim 1 with the sheath comprising silicone on the braided material.
 6. The method of claim 1 with the sheath having a length of 70 to 180 mm.
 7. The method of claim 6 with the sheath having an outside diameter of 12 to 50 mm.
 8. The method of claim 1 further including using a scissor to perform the cutting.
 9. The method of claim 1 further comprising folding the first end of the sheath, grasping the folded first end of the sheath with the distal end of the tool, and releasing the folded first end of the sheath after the first end of the sheath is pulled into the nose.
 10. A surgical method, comprising: providing a surgical sheath comprising a tube of braided material; grasping a first end of the sheath with a distal end of a tool; inserting the distal end of the tool into the nose of a patient; using the tool to pull the first end of the sheath into the nose of the patient; releasing the first end of the sheath, leaving a second end of the sheath projecting out of the nose; and cutting off a portion of the second end of the sheath.
 11. The method of claim 10 wherein the tube has a circular cross section that is uniform along the length of the tube.
 12. The method of claim 10 wherein the sheath comprises silicone on the braided material.
 13. The method of claim 10 wherein the sheath has a length of 70 to 180 mm.
 14. The method of claim 10 further comprising folding the first end of the sheath, grasping the folded first end of the sheath with the distal end of the tool, and releasing the folded first end of the sheath after the first end of the sheath is pulled into the nose.
 15. The surgical method of claim 10 further including leaving 5 to 30 mm of a second end of the sheath projecting out of the nose. 